局限性小细胞肺癌患者胸部放疗后局部区域失败。
Locoregional failures following thoracic irradiation in patients with limited-stage small cell lung carcinoma.
机构信息
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada.
出版信息
Radiother Oncol. 2012 Feb;102(2):263-7. doi: 10.1016/j.radonc.2011.12.009. Epub 2012 Jan 28.
PURPOSE
To determine the patterns of loco-regional (LR) and distant failure in patients with limited-stage small cell lung carcinoma (LS-SCLC) treated with curative intent.
METHODS
From 1997 to 2008, 253 LS-SCLC patients were treated with curative intent chemo-radiation at our institution. A retrospective review identified sites of failure. The cumulative LR failure (LRF) rate was calculated. Distant failure-free survival (FFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Volumetric images of LR failures were delineated and registered with the original radiation treatment plans if available. Dosimetric parameters for the delineated failure volumes were calculated from the original treatment information.
RESULTS
The median follow-up was 19 months. The site of first failure was LR in 34, distant in 80 and simultaneous LR and distant in 31 patients. The cumulative LRF rate was 29% and 38% at 2 and 5 years. OS was 44% at 2 years. Seventy patients had electronically archived treatment plans of which there were 16 LR failures (7 local and 39 regional failure volumes). Of the local and regional failure volumes 29% and 31% were in-field, respectively.
CONCLUSIONS
The predominant pattern of LR failure was marginal or out-of-field. LR failures may be preventable with improved radiotherapy target definition.
目的
确定局限性小细胞肺癌（LS-SCLC）患者接受根治性治疗后的局部区域（LR）和远处失败模式。
方法
1997 年至 2008 年，我院 253 例 LS-SCLC 患者接受了根治性化疗放疗。回顾性研究确定了失败部位。计算了累积 LR 失败（LRF）率。使用 Kaplan-Meier 方法计算无远处失败的无复发生存率（FFS）和总生存率（OS）。如果有，将 LR 失败的容积图像与原始放射治疗计划进行描绘和配准。从原始治疗信息中计算出划定失败体积的剂量学参数。
结果
中位随访时间为 19 个月。首次失败部位为 LR34 例，远处 80 例，LR 和远处同时 31 例。2 年和 5 年的累积 LRF 率分别为 29%和 38%。2 年时 OS 为 44%。70 例患者有电子存档的治疗计划，其中有 16 例 LR 失败（7 例局部和 39 例区域失败体积）。局部和区域失败体积中，分别有 29%和 31%在靶区内。
结论
LR 失败的主要模式是边缘或靶区外。通过改进放疗靶区定义，可能可以预防 LR 失败。
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